CONGENITAL TUBERCULOSIS IN A NEONATAL INTENSIVE-CARE UNIT - CASE-REPORT, EPIDEMIOLOGIC INVESTIGATION, AND MANAGEMENT OF EXPOSURES

Disseminated tuberculosis was diagnosed at the autopsy of a 65-day-old premature infant who died in a 52-bed neonatal intensive care unit (N ICU). Both parents and one sibling had previously had positive tubercu lin skin tests (TSTs); none had active pulmonary tuberculosis, but a s econd sibling had hilar adenopathy. Congenital transmission was confir med by isolation of Mycobacterium tuberculosis from the mother's endom etrium and the infant's lung tissue. Both strains were identical by DN A restriction fragment analysis. TSTs were performed on 14 neonates, 2 7 NICU visitors, 11 contacts of the family, and 260 health care worker s. TST conversion occurred in two nurses (0.8%); both had normal chest radiographs and received isoniazid therapy. Exposed neonates had nega tive chest radiographs, had negative gastric aspirates for acid-fast b acilli, and received isoniazid preventive therapy. Diagnosis of congen ital tuberculosis requires a high index of suspicion. Transmission of tuberculosis in the NICU setting is unusual but can occur.